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Full text of "United States Navy Medical News Letter Vol. 27, No. 5, 2 March 1956"

« 



NavMed 369 




UNITED STATE S NAV Y [ 



Editor - Captain L. B. Marshall, MC, USN (RET) 



Vol. 27 



Friday, 2 March 1956 



No. 5 



TABLE OF CONTENTS 

CAKEER INCENTIVE BILL. Statement of the Surgeon General, State- 
ment of the American Medical Association 2 

Surgery for Coronary Artery Heart Disease 6 

Recurrence of Carcinoma at Anastomotic Site 9 

A Study of Retinoblastoma H 

The Use of Dionosil in Bronchography 13 

High Intensity Noise 14 

Malaria - A Challenge of Mankind 17 

A Letter from CNO 20 

BuMed Circular Letters 20 

Postgraduate Short Courses for Medical Officers . 20 

Radiobiology Course 22 

Symposium on Acute Trauma 23 

From the Note Book 23 

Physical Disability Discharge, Certificate for {BuMed Inst. 1920) 25 

Professional and Technical Books (BuMed Inst. 6820. 4C) 25 

DENTAL SECTION 

Correspondence Course Guide for Dental Officers 26 

Films Available at District and Fleet Film Libraries 28 

MEDICAL RESERVE SECTION 

Available Appointments in Medical Service Corps, USNR 29 

Medico-Dental Symposium for Armed Forces, 1st Naval District 30 

X-Ray Physics and Techniques - New Correspondence Course 31 

PREVENTIVE MEDICINE SECTION 

Poliomyelitis Vaccine • 32 

1956 Industrial Health Conference 34 

Postgraduate Training in Preventive Medicine • 35 

Postgraduate Course in Venereal Disease 36 

Errata in Flip Charts for Food Service Training 36 

■in 

Immersion Foot 

Loaded Projectiles Used for Display at Naval Hospitals . 40 



2 



Medical News Letter, Vol. 27, No. 5 



CAREER INCENTIVE BILL 



Statement of Rear Admiral B. W. Hogan, Surgeon General, U. S. Navy , 
on H. R. 8500, February 16, 1956 

"Mr. Chairman and Members of the Committee, I appreciate deeply 
the opportunity to appear again before your committee and to testify as to 
the need for enactment of H. R. 8500. 

It is no understatement to say that the continued loss of career naval 
medical and dental officers is the most serious problem I have had to cope 
with as the Surgeon General of the Navy. 

This loss has been staggering! 

In the last two fiscal years (54 - 55) the Regular Navy Medical Corps 
has lost through resignation almost 300 medical officers. In addition some 
'0 were lost through death or retirement. Similarly, during this period 
ere were 90 resignations of dental officers. 

To replace these losses we received only 55 new dental and only 39 
.ew regular medical officers-all but one of whom went immediately into 
residency training, (the quid pro quo for their part of the bargain) Of the 
55 dental officers, 15 were attracted by dental intern training. 

The continuing loss of our trained career doctors is reflected in all 
phases of our function. — 

It is becoming more difficult to maintain acceptable standards of 
medical care in our hospitals, aboard ship, with the Marine Units—in fact 
in all of our medical activities. ' 

Our contribution to the safety program necessary for nuclear pro- 
pulsion IS in danger of being curtailed and our participation in fleet readi- 
ness has had to be reduced to absolutely bare essentials-. 

In the fields of radioactive isotopes and in preventive medicine — 
where formerly the military doctor pioneered-we are not even able to 
supply enough doctors for our teaching staffs. 

The one basic reason for this unprecedented resignation rate is 
inadequate pay for doctors in military service compared with income levels 
they can command in civilian practice. It explains, in part as well, the ex- 
treme unpopularity of doctors' draft legislation. Incomes for doctors, even 
m Civil Service or in the Veterans Administration are far more attractive 
than what the military service can offer. 

. General of the Navy, it is my responsibility to the Secretary 

of the Navy and to the Chief of Naval Operations within the Department of 
Defense, and of all of us to the Congress to insure a satisfactory level of 
medical care for Armed Forces personnel and to maintain adequate health 
standards in the many and far flung activities in which our people are involved. 
To discharge this responsibility it is imperative that we maintain a hard core 



Medical News Lictter, Vol, Z7, No. 5 



3 



of career doctors specially trained in the arts and science of military 
medicine to support our Marines in the field, our fleets on or under the 
seas and our planes in the air as well as in clinical, industrial and research 
fields . 

I would be remiss in my duties if I did not sound the warning that we 
are in grave danger of losing all semblance of a career corps under the 
present low pay scales. 

It is my opinion that the time for action is now. If the income for 
doctors in uniform is not substantially increased we will not be able to 
compete successfully with the attractions offered in private practice and 
the other government medical services. Military medicine, as such, will 
be a thing of the past and the military services will suffer accordingly. 

Again my sincere thanks to you, Mr. Chairman, and your Committee, 
for the understanding and sympathetic consideration you are giving to the 
solution of this important problem." 



STATEMENT OF THE AMERICAN MEDICAL ASSOCIATION 

Re: H. R. 8500, 84th Congress 
Medical and Dental Officer Career Incentives Bill 

Before Subcommittee No. 2 
House Armed Services Committee 

By Harold C. Lueth, M. D. 
February 16, 1956 

Mr. Chairman and Members of the Committee: ^ 

I am Dr. Harold C. Lueth of Evanston, Illinois, where I am engaged 
in the private practice of m.edicine. As a member of the Council on National 
Defense of the American Medical Association, I appreciate the opportunity 
of appearing before your Committee today to discuss H. R. 8500. 

It is our understanding that the purpose of this legislation is to promote 
the procurement programs of the military medical services by increasing 
the attractiveness of a military career. As Dr. Hamilton has said, the 
American Medical Association supports this bill as a step in the right direc- 
tion. We do not believe, however, that it goes far enough in removing the 
financial and professional handicaps under which the current procurement 
programs of the Armed Forces are operating. 

While the proposed bill would authorize longevity pay credit for the 
four years a physician spends in medical school and for the additional year 



4 



Medical News Letter, Vol. 27, No. 5 



of internship training, this would result in only a token increase in pay 
and rank. Similarly, while the bill authorizes the upgrading of medical 
officers now on active duty by giving constructive service credit for this 
same period, it would have slight immediate effect. The longevity pay in- 
crease ranges from $31 to $76 a month, depending upon rank and length of 
service. In most instances, the constructive service credit will not being 
about a marked acceleration in promotion. 

Our Armed Services have not been able to compete financially even 
with other Federal medical services. Minimum starting salaries for phys- 
icians under civil service regulations range from $7500 to $8000 annually 
as compared to an approximate $6000 annual pay and allowance for military 
medical officers with comparable training and experience. Moreover, the 
average pay of a specialist (a Board certified physician) inthe Veterans 
Administration is over $12. 000 annually_an income which a military phys- 
ician can hope to achieve only after twenty-five years of service and assum- 
ing that he attains the rank of colonel. Civilian salaried positions available 
to physicians are at least comparable to the Veterans Administration pay 
scale, and the income possibilities may be even higher for physicians 
engaged in the private practice of medicine. Obviously, it will require a 
larger incentive pay than provided in this bill to place the military services 
m a reasonable, competitive position in obtaining and retaining qualified 
physicians. 

The American Medical Association has long been concerned v^ith the 
physician loss rate of the military medical services. We feel that this is a 
trend which must be reversed for several reasons. There is no question that 
the efficiency of military medicine is impaired by the constant turnover of 
medical officers. Not only is much of the time of these transient officers 
spent in processing, orientation, travel and separation, but there is a loss 
of accumulated experience. It is obvious that this turnover of medical persbn- 
nel IS expensive. We are also of the opinion that a lack of stabiHty in the 
Medical Corps detracts from the professional prestige of military medicine 
and tends to aggravate the loss rate. Finally, it is apparent to us that one 
of the most readily available solutions to the problem of the special draft 
of older physicians lies in the development of a realistic program for attract- 
ing and retaining an adequate number of well qualified physicians on active 
duty voluntarily. 

We do not mean to imply that a financial inducement is the sole solution 
to this problem nor that other features of military service should be over 
looked. Since 1952. the American Medical Association, through its Council 
on National Defense, has conducted a continuing survey of physicians being 
released from military service. This survey is primarily designed to obtain 
information on the utilization of physicians in military service and on medical 
staffing conditions in the Armed Forces. 

The questionnaire used solicits comment as to the conditions under 
which physicians returning to civilian life would be willing to remain on 



Medical News Letter, Vol. 21, No. 5 



5 



active duty. Based on replies from over 9400 individuals, approximately 
one-third would not have been interested in remaining on active duty under 
any conditions short of total war. Another oAe -third indicated that their 
decision to return to civilian life was predicated on miscellaneous reasons, 
which could not be met under any feasible procurement program. It is the 
remaining one -third which an effective career incentive program can reach 
Interestingly enough, our survey generally substantiates the conclusions 
reached by the Grenfell Task Force of the Department of Defense in the fall 
of 1955. 

Promotion to higher rank, increase in pay, further specialty training, 
an opportunity to practice their specialty, more stability in assignment and 
improved living conditions for their families are all items which this group 
of physicians indicated would have significantly influenced their decision. 

I should like to take this opportunity to commend the Department of 
Defense for its recognition of existing conditions and for the action it has 
already taken and plans to take to bring about necessary administrative im- 
provements. 

The American Medical Association is independently attempting to make 
military medical careers more attractive by increasing the prestige of mil- 
itary medicine and promoting better professional understanding between the 
military physician and his civilian colleague. 

I should like to give you a few examples of our efforts. The Army, Navy, 
and Air-Force are represented in our House of Delegates by representatives 
appointed by the Surgeons General of the respective services. Our scientific 
exhibits emphasize the attractive scientific and research aspects and accom- 
plishments of military medicine. The Journal of the American Medical 
Association and the other specialty journals published by the AMA regularly 
report military medical activities and the results of original research and 
clinical accomplishments by military physicians. Our Council on National 
Defense, concerned largely with military medicine, is one of the ten stand- 
ing Committees of the Board of Trustees. It maintains close contact with 
the problems of military medicine. We have endeavored by several means 
to foster and promote closer professional association between military 
medical officers and the county and state medical societies. 

The services and the medical profession can do much to solve the 
problem of the vanishing career medical officers. The largest single item 
in the solution, however, falls squarely with the responsibility of Congress. 
We have previously pointed out to this Committee the financial disadvantage 
of the medical officer as compared with a line officer of the same age. 

We agree with the Department of Defense that one of the major causes 
of our present situation is the disparity between the incomes of military 
physicians and other physicians. The disparity between the financial 
position of the medical officer and the line officer is an important con- 
tributing factor. The fact that the 1955 Grenfell Task Force, headed by 



6 



Medical News Letter, Vol. 27, No. 5 



line officers, recognized and reported this situation is a source of satisfac- 
tion to the medical profession. 

H. R. 8500 would enact into law two of the three legislative recom- 
mendations of this Task Force. While we are not committed to support the 
suggested contract bonus which constituted the third element of the recom- 
mended legislative program, we urge this Committee to examine this pro- 
posal carefully. We believe that there may be alternative methods —perhaps 
a substantial increase in incentive pay after the initial period of service; 
a mechanism similar to the reenlistment bonus now authorized for enlisted 
men; or even a service bonus similar to the one which proved satisfactory 
in retaining qualified officers in the Air Corps Reserve during the 1920 's 
and 1930's. We are not committed to any particular method, but we are 
certain that, in addition to steps already taken or planned, it is essential 
that an adequate financial inducement be provided to place the military 
medical services in a more favorable competitive position than that which 
they occupy at present. 

Finally, on behalf of the American Medical Association, we pledge 
our continued efforts to cooperate with the Department of Defense in strength- 
ening and promoting the prestige and effectiveness of the military medical 
services. Thank you, Mr. Chairman. 

Dr. Hamilton and I will be glad to attempt to answer any questions. 

****** ' . 



Surgery for Coronary Artery Heart Disea se 

Effective treatment for the patient with coronary artery heart disease 
must achieve four cardianl aims: (1) prolong life, (2) reduce invalidism and 
disability, (3) maintain productivity and well-being, and (4) relieve pain 
and discomfort. 

Obviously, the ultimate solution is that of prevention of the occlusive 
process in the coronary arteries by medical means. Until this can be 
achieved, the patient with coronary artery heart disease must be given the 
benefit of any procedure which safely and effectively accomplishes the 
four aims. Standard medical therapy, which always includes some degree 
of restricted activity, may achieve aim number 4 at the expense of 2 and 3, 
with only questionable influence on 1. So-called radical measures, such 
as thyroid ablation, by medical or surgical means, also may relieve pain 
and discomfort, but certainly at the expense of aims number 2 and 3, and ' 
probably of 1. Neurosurgical procedures for interruption of pain pathways 
frequently achieve aims number 4 and 3 for variable periods, but, unfor- 
tunately, do not influence 1 and 2. It can be demonstrated that operation is 
a practical method for achieving all four aims. 



Medical News Letter, Vol. 27, No. 5 



7 



This report is based upon observations on more than 200 patients 
operated on for coronary artery heart disease with special reference to a 
series of 75 consecutive patients operated on since July 1952 at Mount Sinai 
Hospital, Cleveland. Of these 75, the first 13 had the Beck 11 procedure, 
the remainder the Beck I. The simplicity and lower operative mortality 
have made the latter the procedure of choice in view of the equivalent degree 
of benefit provided. 

The one indication for operation is a positive diagnosis of coronary 
artery heart disease. Operation should not be considered a salvage procedur 
to be applied only when medical treatment has failed. Ideally, operation is 
performed before there is any significant muscle damage. Early provision 
of a collateral circulation could save patients who would die of their first 
'coronary attack. " 

Classification of patients with coronary artery heart disease is par- 
ticularly difficult. Consideration must be given not only to the degree of 
myocardial damage, but also to the progression of the occlusive disease 
in the coronary arteries. In general, the following broad classification has 
been found useful: 

Group I. Mild disease. Usually under 50 years of age. Mild to mod- 
erate angina of effort. May have old infarct with little or no angina. (Oper- 
ative mortality less than 3%). 

Group II. Moderately advanced disease. One or more myocardial 
infarcts. Moderate to severe angina. May have bouts of coronary failure. 
(Operative mortality less than 5%). 

Group m. Salvage. Poor operative risk, not much benefit expected. 
Extensive muscle damage. Sudden recent progression of symptoms. Status 
anginosus. Specific contraindications. (Operative mortality approximately 
12%). 

Operation is specifically contraindicated if there is so much muscle 
destruction that congestive failure has occurred. The small amount of 
benefit that can be achieved does not justify the surgical risk. 

Acute myocardial infarction, or even suspicion of impending infarc- 
tion, absolutely precludes operation for a period of 4 to 6 months. In addi- 
tion to the obvious dangers of operation during the acute stage, the delay 
permits natural development of collaterals. Operation is also particularly 
hazardous in patients with progressively severe anginal p»in without demon- 
strable evidence of previous myocardial infarction. These patients are apt 
to develop areas of ischemia during or immediately after surgery. Presum- 
ably, because of complete lack of collaterals, these hearts are prone to 
'electrical instability" and sudden death. On the contrary, patients with 
extensive muscle destruction and some degree of cardiac enlargment have 
remarkably stable hearts and tolerate operation quite well. However, 
evidence of congestive failure usually means it is too late for much benefit. 

The 75 patients operated in this series were classified as follows; 
Group 1-5, Group II - 44, Group III - 26. 



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Medical News Letter, Vol. 27, No. 5 



The age range was 28 to 72 years with an average of 48 years. In 
general, patients over 65 are poorer risks. Likewise, patients under the 
age of 40 usually have a particularly malignant form of coronary disease. 
In this series, 14 patients were under 40 years and 4 were over 60. Only 
2 were females. 

Generally, the diagnosis of coronary artery heart disease is estab 
lished by the history. Electrocardiographic evidence of myocardial infarc- 
tion merely confirms the diagnosis. Operation has been performed on a 
number of patients who had normal electrocardiograms, even after standard 
tolerance tests. At operation, myocardial scars are demonstrated frequent- 
ly in patients with completely normal serial electrocardiograms. 

All patients shotdd be completely digitalized before surgery. This 
must be done even though there is no evidence of failure. Despite certain 
theoretical objections to the use of digitalis, in the author's experience, 
digitalis (1) decreases the irritability of the heart, particularly during epi- 
cardial abrasion; (2) decreases the incidence of the various supraventricular 
arrhythmias occurring during induction and maintenance of anesthesia; (3) 
appears to aid in maintaining normal stroke volume and heart rate during 
operation; and (4) definitely increases the ease of resuscitation of dogs 
(and. no doubt, human beings) following cardiac arrest. In the opinion of 
surgeon, anesthesiologist, and cardiologist, digitalized patients run a much 
smoother operative course than nondigitalized patients. 

During the operation, the surgeon, anesthesiologist, and cardiologist 
observe close teamwork. Although the surgeon assumes the major respon- 
sibility, the cardiologist is in command. Continuous electrocardiographic 
observation (such as with the cardioscope) is essential. The operation is 
interrupted whenever necessary. The appearance of alarming electrocardio- 
graphic changes (markedly prolonged intraventricular conduction, evidence 
of extensive ischemia) may be sufficient to cause termination of the operation 
at any given stage. 

Postoperatively, these patients do remarkably well. Except for the 
usual thoracotomy discomfort, convalescence is usually uneventful. The 
operation per se does not result in pericarditis pain. If pericardial effusion 
occurs, it drains into the left pleural cavity. However, only rarely is it 
necessary to perform a thoracentesis. On no occasion has pericardial 
tamponade occurred. 

The Beck operation for coronary artery heart disease is a safe and 
effective method for providing a more adequate distribution of available cor- 
onary arterial blood supply to the heart. In preventing unequal oxygenation 
of contiguous areas of the myocardium, electrical stability of the heart is 
maintained. 

Of the last 56 patients operated on. 3 died in the immediate postopera- 
tive period, giving an over -all operative mortality of 5. 4%. A lower mortal- 
ity rate probably cannot be acUeved. in view of the spontaneous mortality in 



Medical News Letter, Vol. 21 , No. 5 



9 



such patients with severe coronary artery heart disease. In a series of 
44 consecutive patients with a long-term follow up of 10 months to 3 years, 
only 3 have died; 38 (86. 5%) have little or no pain, and 37 (84%) are working 
either full time or more than before operation. 

In view of the proved effectiveness of the Beck operation for coronary 
artery heart disease, the demonstration of a very low operative mortality 
(5.4%) removes the operation from the category of salvage procedures and 
justifies its early application to a majority of patients with the disease. 
(Brofman, B. L. , The Clinical Aspects of Surgery for Coronary Artery 
Heart Disease: Medical Annals, District of Columbia, XXV: 1-6, January 
1956) 

****** 
Recurrence of Carcinoma at Anastomotic Site 

Recurrence of carcinoma of the colon at the site of anastomosis is 
encountered with sufficient frequency that further studies of this problem 
seem indicated. Cole found a 16% incidence of local recurrence, two-thirds 
of which occurred at the line of anastomosis following resection of the colon 
and proximal rectum. Goligher and associates also noted the high incidence 
of recurrence at the suture line in similar cases. The present study was 
undertaken to analyze the experience at The New York Hospital and to deter- 
mine the significant factors in recurrences encountered in this institution. 

One hundred and forty patients were subjected to primary resection 
of the colon with intent of cure. The majority of these operations were 
performed by members of the resident staff. As far as could be determined, 
the anastomosis, which was performed in association with each resection, 
was an aseptic type which involved interrupted silk sutures placed through 
the seromuscular layers of the bowel over intestinal clamps. 

Recurrence of carcinoma at the anastomosis occurred in 21 (15%) 
of the 140 patients. It was found that only 2 of these recurrences occurred 
proximal to the splenic flexure. In 5 of the 21, an additional resection of 
the colon was performed for the recurrent carcinoma. One patient, who had 
a recurrence after resection of a carcinoma of the splenic flexure, has sur- 
vived 7 years since the second operation without evidence of carcinoma. 
One patient with carcinoma of the descending colon had two secondary resec- 
tions of the colon because recurrences developed. Each recurrence was 
detected 3 years subsequent to the previous operation. One year after the 
third resection, exploratory laparotomy was performed and liver metastases 
were found without evidence of local recurrence in the colon. The remaining 
three patients died of extension of carcinoma within 3 years of the second 
operation. 

Cole has postulated that the implantation of exfoliated tumor cells upon 
the suture line at time of operation is responsible for recurrence. Goligher 



10 



Medical News Letter, Vol. 27, No. 5 



and associates have presented data that support this view. One of the 
most striking features in the present analysis of recurrences at the site 
of anastomosis is the marked difference in incidence between the mid- and 
right portions of the colon and the left portion. There were only two anas- 
tomotic recurrences in the 49 resections proximal to the splenic flexure, 
a recurrence rate of 4. 1%. In the 91 resections for carcinomata originating 
in the splenic flexure, descending colon, and sigmoid colon, 19 recurrences 
were observed — an incidence of 20. 9%. The operative technique in this 
series did not vary greatly. Manipulation of the tumor was certainly involved 
in both areas. If exfoliation of tumor cells is the predominant feature, then 
one might not expect such a great difference in the incidence of recurrence 
between the two portions of the colon. Because the lumen of the colon is 
relatively empty at the time of operation, there would appear to be a com- 
parable opportunity for intraluminal dissemination of exfoliated cells, if 
this was a major factor. 

Methods for preventing recurrence of carcinoma at the anastomotic 
site warrant further study. Cole has suggested occlusive ligatures about 
the wall of the colon both proximal and distal to the tumor and transection 
beyond the ligatures. Goligher and associates have -^recomm ended irriga- 
tion of the distal segment followed by excision of the exposed cuff of bowel. 
Baker has undertaken intraluminal inspection of the remaining portion 
of the colon by means of a proctoscope or sigmoidoscope at the time of 
resection. It would appear that there is merit in these suggestions and 
that all should be investigated. It is important to consider each factor con- 
tributing to local recurrence when a resection is performed for carcinoma 
of the colon. In extending the limits of resection of the bowel in the treat- 
ment of carcinoma of the left side of the colon, proximal extension of the 
line of resection has generally received emphasis. It seems equally impor - 
tant to extend the distal line of transection as far as possible This site 
should be selected early in the operative procedure. The proximal clamp 
across the bowel should be applied first. In resections of the left colon, 
it may be advisable to attempt to place the anastomosis within reach of 
the sigmoidoscope. Further, the information available seems to lend in- 
direct support to the concept of left hemicolectomy for carcinomata arising 
in the left portion of the colon. Future analyses will be required to see if 
the extension of the limits of resection for carcinoma of this portion will 
result in a diminished incidence of local recurrence. 

Whether the advantages of irrigation of the distal segment, as suggested 
by Goligher, has sufficient merit to outweigh the possibility of contamination 
of the wound and peritoneal cavity, remains to be determined. The specimen 
obtained should be inspected by the pathologist or surgeon to determine that 
the margin is adequate and to determine if papillomata are present. Cer- 
tainly, the remainder of the bowel should be carefully searched for satellite 
papillomata or other neoplasms. The follow-up period should include 



Medical News Letter, Vol, 27, No. 5 



11 



repeated investigations for evidence of papillomata and for the develop- 
ment of new neoplasms. When a recurrent carcinoma is suspected at the 
site of anastomosis, prompt intervention should be undertaken. Although 
the prognosis is poor when recurrence is detected, resection may result 
in prolonged survival in some instances, and should be attempted. (Beal, J. M. , 
Cornell, G. N. , A Study of the Problem of Recurrence of Carcinoma at the 
Anastomotic Site Following Resection of the Colon for Carcinoma: Ann. 
Surg., 143 : 1-6, January 1956) 

A Study of Retinoblastoma 

Eyes from 176 cases of retinoblastoma, submitted to the eye pathology 
laboratory of the Massachusetts Eye and Ear Infirmary, served as a basis 
for this statistical study. 

In accordance with the decision of the Committee of the American 
Ophthalmologic al Society to Investigate and Revise the Classification of 
Certain Retinal Conditions, the term retinoblastoma has been applied to 
all tumors of this type. In this series, the tumors have been placed in one 
of two groups, those with few or no rosettes (complete, incomplete, or 
pseudo ) and those with many rosettes (complete, incomplete, or pseudo-). 
This grouping of the tumors was applied to those specimens received by the 
laboratory before and after 1930. For the period 1898 to 1929, there were 
available for complete examination 76 specimens. Twenty-eight of these 
showed many, and forty-eight showed no rosettes, or few, in most sections. 
For the period 1930 to 1951, complete examination was possible of 101 
specimens.. Of these, 55 showed many and 46 none or only a few rosettes. 
Thus, 83 specimens showed many rosettes and 94 showed few or none. In 
cases with bilateral involvement, 4 had many rosettes bilaterally, 5 had 
none or few bilaterally. Four had many rosettes in one eye and few or none 
in the other. 

The degree of optic -nerve involvement was broken down into two groups: 
with extension of the tumor beyond the lamina cribrosa or to the lamina. 

Of these eyes, with involvement of the optic nerve to the lamina cribrosa 
or beyond, 31 had tumors with many rosettes and 38 had tumors with few or 
none. 

Tumor was present within the choroid of 6l eyes (34. 5%). Eighteen 
of these eyes had tumors with many rosettes and 43 with few or none. In 
19 eyes (10. 7%) extrascleral extension was present. Three of these had 
tumors with many rosettes and 16 had few or none. 

Among those cases with many rosettes, 33% had symptoms longer 
than 3 months before treatment, and 15. 5% longer than 6 months. Among 
those with few or no rosettes, 62% had symptoms longer than 3 months and 
44% longer than 6 months before initial treatment. 



12 



Medical News Letter, Vol. 27, No. 5 



History was obtainable for 28 cases with tumor within the choroid. 
Nineteen (68%) had symptoms longer than 3 months before treatment, and 
13 (47%) longer than 6 months. 

The followed -up series contained 40 cases of tumors with many ro- 
settes and 33 with few or none. One fatality and two survivors had bilateral 
disease with many rosettes in one eye and few or none in the other. Three 
(7. 5%) of those having tumors with many rosettes, and 14 (42. 4%) of those 
having few or none, have died of the disease. Of those who died of tumor, 
7 had malignant cells in the cut end of the optic nerve, 5 had extrascleral 
extension, and 3 had massive involvement of the choroid. It is assumed 
that massive choroidal involvement is an explanation of fatality. From the 
fatality group, 13 of the 18 showed some choroidal involvement, while 
among the survivors, only 11 of the 62 showed this involvement. Three 
tumor fatalities offered no adequate explanation of the cause of death from 
examination of the specimens because of poor preservation. The example 
of "possible" tumor death probably had extrascleral extension, but this 
specimen was poorly preserved. Three fatalities are known to have had 
generalized metastases. 

The mean delay in treatment in this series was 4. 9 months. When 
the series is broken down into those cases occurring before 1930 and since, 
it is apparent that in later years treatment has been earlier. Before 1930, 
49%, and since that date only 17%, had symptoms longer than 6 months 
when first treated. In the adequately followed group, 15% of the survivors 
and 44% of the fatalities had symptoms longer than 6 months before treat- 
ment was begun. Considering this difference between survivors and fatal- 
ities and also the greater percentage of 3-year (and hence probably perma- 
nent) cures since 1930 than before, prompt treatment of the disease, when 
it is discovered, would seem to play a significant role in the chances of 
effecting a cure in any given case. This is also reflected in the degree of 
choroidal involvement because 47% of those with choroidal involvement 
had symptoms longer than 6 months before treatment was instituted. The 
number of cases with extrascleral extension, for which histories were 
obtainable, is small and no definite trend is shown. Prompter treatment 
since 1930 is indicated by the decrease in involvement of the optic nerve 
by tumor beyond the lamina cribrosa, 41% before 1930, and 21% since 
that date. Reese reports a similar decrease in recent years. 

Examination of these specimens for the purposes of classification of 
the tumors revealed that there is no clear cut dividing line between the two 
groups, with and without rosettes. Even the tumors containing the fewest 
rosettes were likely to present some true rosettes in certain sections, 
while those with many usually had free areas. Accordingly, it is the belief 
of the authors that the use of a single name to describe all tumors of this 
general type is justifiable, and that variations in the histologic picture are 
consistent with variations in the degree of differentiation of the same tumor. 
No effort has been made to determine the origin of the growth. 



Medical News Letter, Vol. 27, No. 5 



13 



Certain data suggest that the longer the tumors are present before 
treatment, the more undifferentiated they become. It may be reasoned that 
the very few rosettes seen in tumors with fatal outcome is the consequence 
of longer existence of the growths before enucleation, rather than that the 
lethal outcome stems from primary undiff erentiation. (Herm, R. J. , 
Heath, P., A Study of Retinoblastoma: Am. J. Ophth. , 4I_: 22-29, January 
1956) 

The Use of Dionosil in Bronchography 

The search for ideal agents to be used in contrast roentgenography 
is a continuous one, and in no field is their need more keenly felt than in 
bronchography. For that procedure, it is highly desirable that the follow- 
ing objectives be met: 

1. The degree of irritation produced by the medium should be of 
sufficiently low degree that bronchography may be performed with a min- 
imum of effort and with the least pos sible post-brohchographic complications. 

2. The contrast agent should so outline the bronchial tree and provide 
such roentgenographic contrast that maximum diagnostic utility is attained. 

3. While the foregoing criteria are probably most Important, it is 
also desirable that the contrast medium be removed or absorbed so that 
later roentgen diagnostic study of the chest may be of maximum benefit. 

In the authors' experience, these criteria have been fulfilled best 
by N propyl 3 :5-di -iodo-4 pyridone -N-acetate (propyliodone), manufactured 
under the trade name of Dionosil. The present article reports results 
obtained with this contrast medium in 74 bronchographic examinations in 
68 patients. 

Both aqueous and oily Dionosil proved to be far less irritating than 
aqueous Diodone (Xumbradil). The authors found that Dionosil allows an 
unhurried performance of a more satisfactory examination, being compara- 
ble in this respect to Lipiodol and lodochlorol. 

In all of the patients, contrast filling of the bronchial tree was adequate, 
as demonstrated in the 3 views described. In 3 instances, diagnostic bron- 
chograms were not obtained because of technical difficulties, but subsequent 
attempts in these same patients were successful. 

The tendency to outline the bronchi, with production of a double contrast 
effect, was noted in many bronchograms. Occasionally, a small amount of 
contrast material entered the alveoli, but not to the degree observed follow- 
ing the use of Lipiodol and lodochlorol. 

Chest roentgenograms were obtained 24, 48, and 72 hours following 
bronchography in order to estimate the degree of clearance of opaque sha- 
dows from pulmonary structures. In patients in whom this was not possible. 



14 



Medical News Letter, Vol. 27, No, 5 



a roentgenogram was obtained at the earliest possible date. The authors 
were unable to obtain a follow-up roentgenogram in 7 cases. From a com- 
posite study of the remaining examinations, it was estimated that over 75% 
of the contrast material had disappeared from the pulmonary fields within 
24 hours. In 48 hours, over 90% had disappeared, and in 72 hours, usually 
only a trace or none at all could be seen. 

Diagnostic bronchograms were obtained with both the oily and aqueous 
suspensions of Dionosil. The oily suspension is, perhaps, less irritating, 
but also shows a slightly greater tendency to enter the alveoli, which may 
be responsible for the slightly slower clearance observed on postbroncho- 
graphic roentgenograms. Norris and Stauffer found that the oily medium 
may require one or two days longer for complete clearance. 

F ew complications, followdng the use of either aqueous or oily sus- 
pensions of Dionosil, were observed, A slight cough was noted in about 10% 
of the patients. In this respect, the oily medium seems slightly less irritat- 
ing than the aqueous preparation, A temperature elevation, confined to the 
day following bronchoscopy and usually not exceeding 100° F. , occurred in 
8 patients. This pyrexial reaction subsided spontaneously without specific 
medication. In 3 patients, slight headache, sore throat, and shortness of 
breath developed, subsiding the following day. Whether these were due to 
the procedure as a whole or to the contrast medium is not clear. Two 
patients had clinical signs of pneumonia following bronchography, but in 
only one was there roentgen evidence of the disease. 

Many advantages and no disadvantages are noted when Dionosil is 
compared with the iodized oils and Xumbradil Viscous B for bronchography 
(Nice, Jr., CM., Azad, M. , The Use of Dionosil in Bronchography: 
Radiology, 66: 1-7, January 1956) 

****** 
High Intensity Noise 

A report states that in high intensity noise and particularly as it 
appears on the flight deck of the carrier, a situation that is new in man's 
experience is present. The noise levels are higher than any in which man 
has previously lived and carried out military operations. It is not known 
exactly what exists except that it is known that a stress is present — some - 
thing that is making it more and more difficult for men to carry out their 
military duties. One very obvious difficulty is interference with com- 
munications. The whole operation of the ship is involved in the difficulty 
of communication by mouth and by ear. Then, above that, there is the 
question of what is happening to the men in the really intense noise field, 
down close by the jets. 

The jets have really made this problem and the afterburner on the 
jets makes it still worse. Surveys have shown so far that this noise is 



Medical News Letter, Vol. Z7, No. 5 



15 



affecting the hearing of the men who are regularly and repeatedly exposed 
to it. A significantly greater percentage of hearing losses in the high fre- 
quencies among the men on the flight deck have been found. This seemed 
to be related to the particular position or particular job they were doing 
and to the noise sources. 

Fortunately, there is something that can be done about the loss of 
hearing. The hearing loss begins at high frequencies and, therefore, does 
not cause trouble in hearing speech until it is pretty well advanced, so that 
a warning signal is present. High-tone hearing losses are now being pro- 
duced, but with ear protectors, something can be done about them. This 
is a matter of getting ear protection on the man. With present noise levels, 
this will check the loss of hearing now going on. While ear protectors are 
not yet perfect, they are, nevertheless, adequate if the nec essary compro- 
mises, in regard to acceptability and to the operational problems of getting 
the ear protection on and keeping it there, are successfully worked out. 
Hearing can be protected by the regular use of presently available ear pro- 
tectors. 

However, there is still the possibility that other things besides effects 
on hearing are taking place in the way of cumulative buildup of stresses of 
one sort or another that cannot be identified at the present time. The 
physical stress and strain of the buffetting is very considerable. Also, 
there is the continuing trend toward increase in power of aircraft. It is 
known that the trend is continuing toward greater power in the power plant; 
that means more energy which in turn means more energy inevitably lost 
as noise and a tougher situation for the man. If the noise can be reduced 
at the source, that is wonderful; work is going on trying to do that by im- 
provements in the design of the engines and exhaust. At most, it will buy 
a certain amount of time, but will not change the nature of the ultimate 
problem. The recommendations that came out of the Benox evaluation in- 
cluded starting to find out what is going on. Are there cumulative effects? 
Does the stress cause chronic fatigue or possible cumulative injury to the 
nervous system or to the sense organs? Are there "non -auditory" effects, 
perhaps in the nervous system, the lungs, the digestive system? 

This kind of noise is in just one place — the immediate vicinity of the 
exhaust engines of modern jet engines. That means, practically, that the 
flight -line maintenance man and the carrier deck crews are the main groups 
exposed. Also, the situation is not reproduced under laboratory conditions. 

Preparations are being made to carry out a joint project between the 
Central Institute for the Deaf and the School of Aviation Medicine at Pensa- 
cola. The project involves building a mobile laboratory that can go aboard 
a carrier and study the problem where it exists. There are three or four 
phases of this project. One is to get better measurements of the noise with 
which to relate any biological effects that are picked up. The second is to 
measure the effects on hearing and relate the hearing losses to the noise. 
The third is to study the effectiveness of protective measures. Ear protectors 



16 



Medical News Letter, Vol. 27, No. 5 



will be used; they are still being improved and this study will afford an 
opportunity to evaluate them in the field. The fourth is to watch for non- 
auditory effects. The fifth is to observe by neuro -psychiatric techniques, 
and to carry out certain routine medical observations. 

The laboratory in question, the mobile laboratory, is a trailer, 40 
feet long, 8 feet wide, 11-1/2 feet high, and weighing some 10 tons. It 
has a double shell construction for sound treatment and constitutes a really 
useful laboratory space. It will have one room large enough to hold ten 
subjects simultaneously for so\ind treatment and another room where the 
physiological and psychological tests and examinations can be carried out; 
also a control room for laboratory apparatus and air conditioning. 

Another part of the project is to develop a "fixed" laboratory at the 
School of Aviation Medicine where the corresponding equipment will be set 
up and corresponding studies carried out. The purpose of the fixed instal- 
lation is two -fold; to get controlled observations (a base-line from which to 
take off); and -to try new tests, to develop techniques, and get them in good 
working order before they go to sea. A continued rotation of tests must 
be developed or selected from the tests already developed. Actually, this 
has been going on; the fixed laboratory has been in operation on a temporary 
basis. Of the original ten tests selected, five have been eliminated, either 
as being impractical for some reason or because they duplicated one another 
too much. The second trial on another group of tests is about to begin and 
will be continued. 

For measuring hearing, a group audiometer with several novel features 
to fit particular needs has been developed. There is no one group audiometer 
that is best for all situations. Here, there is need to study things quickly — 
immediately after the men come down from the flight deck. Also, a wide 
range must be covered from normal to complete loss of hearing because 
some of the men have total loss at high frequencies. 

On the noise measurement front, it is encouraging that microphones 
have been improved so that confidence in the accuracy of the microphones, 
to, be used in these high intensity noise fields, exists. A telemetering 
device, a microphone, and a short wave broadcast unit about the size of 
a two-pack hearing aid of the old style, which can be put on individual men 
without encumbering them seriously, is being developed. The continuous 
story of what the noise is at the microphone can then be obtained, and just 
what this particular man undergoes as he carries out his particular duties 
around the planes can also be obtained. This will be an important advance 
because the problem here is really oriented to the man; it is the story of 
the man's exposure to the noise. 

An instrument for measuring noise exposure, called the "noise cumu- 
lator, " is being developed. This instrument will tell how much of the time 
the noise has been at the level of 125 db. or more, how much of the time at 
130 db. or more, how much at 140 db. or more, at 145 db. et cetera. Six 



Medical News Letter, Vol. 27, No. 5 



17 



or seven particular levels can be selected and a direct reading of how much 
time at an individual level can be gotten. It is not only a matter of intensity 
and frequency, but of how much time the man is subject to this stress. 

The idea is, in summary, to test the men before, to test them during, 
and to test some again at the end of a tour of duty with the noise, and then 
to see what has been obtained. (Davis, H. , High Intensity Noise: Annual 
Research Conference, Bureau of Medicine and Surgery, Report, pp. ,103- 
106, May - June 1955) 

jjc ijc ^ sjc ^ 

Malaria - A Challenge to Mankind 

Three hundred million cases and three million deaths was the yearly 
toll which malaria was estimated to take in the world before present control 
methods were used. Most people now know that malaria is an infection 
transmitted by certain species of mosquito known as anopheles. 

Nowadays, anyone living for some time in a territory where there is 
a risk of contracting malaria can probably escape it by taking an adequate 
weekly dose of one of the antimalarial drugs which have been in use since 
the last war (amodiaquine, chloroquine, proguanil, pyrimethamine). If 
living quarters are screened, so much the better; if not, it will be neces- 
sary to sleep under a mosquito net and to limit exposure to the bite of the 
insect as far as possible when outside the mosquito net. It would be unwise, 
for instance, to spend a considerable part of the night at the bridge table 
in a house where mosquitoes have free entry. 

Action of this kind to protect against malaria is like boiling or filter- 
ing a personal water supply to make it safe. But, even so, this does not 
relieve the public authorities of their responsibility for protecting water 
supplies. In a similar way, governments today are undertaking the control 
of malaria over vast regions — a project unheard of a dozen or so years ago. 

The ancient Romans realized that there was some connection between 
marshes, mosquitoes, and fevers. They made what might, perhaps, be 
called the first attempts at preventive medicine by introducing mosquito 
nets and drainage. 

The mosquito net, already in use in ancient Egypt, was very likely 
invented less as a protection against fevers than against the troublesome 
insects which spoiled the beauty of women's faces. If, as Horace tells, 
Cleopatra on her journeys with Antony slept under a mosquito net, there is 
reason to believe that it was not just to protect herself against malaria. The 
draining of marshes, however, may have been intended to serve sanitary 
and agricultural purposes. 

The engineer Vitruvius, contemporary of Augustus, who may be con- 
sidered a forerunner of the modern sanitary engineer, maintained that 



18 



Medical News Letter, Vol. 27, No. 5 



"heavy and substantial vapors" rise from undrained marshes. Although he 
built canals for the drainage of swamps {and reduced the number of mosquitoes) 
he did not solve the problem of malaria, for the anopheles of the Roman cam 
pagna lay their eggs not only in stagnant water, but also in the slowly moving 
water of canals and ditches. 

Vitruvius should have been born in the United States of America some 
centuries later, for the principal anopheles of the country. Anopheles quad- 
rimaculatus , does breed only in stagnant water. If, on the other hand, 
Vitruvius had been born in Manila, he would never have thought that drainage 
could protect against fever, for in the Philippines, the vector lays its eggs 
in running water. 

At the end of the last century, quinine began to be produced on a large 
scale and great hopes were raised by this drug, because it was known that 
a daily dose protected against fevers, even if it did not prevent infection. 
Today, much more effective drugs than quinine, like those mentioned earlier, 
are obtainable. By using these, malaria can undoubtedly be wiped out among 
small groups. But how could these products be administered weekly, or 
even once a fortnight, to millions and millions of people? It would be a task 
beyond the powers of any health administration to enforce such a discipline. 

When, in 1898, it was proved that malaria is only transmitted by 
anopheles, it seemed that a way had been found to control the disease. Even 
if it were not possible to suppress the anopheline breeding -places by drain- 
age and filling (both very expensive measures) it should be feasible to spread 
larvicidal substances on their surfaces. This was done between the two 
world wars— the period of oiling or using "Paris green. " Crude oil was 
poured on breeding places every 10 to 15 days; or they were treated with 
a mixture of road dust and 1% "Paris green. " In this way, all anopheles 
larvae were killed, and, provided that the operation was efficiently carried 
out, malaria could be overcome. 

Unfortunately, however, malaria is preeminently a rural disease; 
it is a disease of villages and hamlets. It is for this reason that malaria 
is important to all — even to countries where it does not exist — because it 
prevents the cultivation of fertile land and, thus, reduces the production of 
food supplies in a world which is short of them. 

Recently, the myxomatosis virus appeared in France (and elsewhere) 
and spread so quickly that almost all rabbits were destroyed. Although this 
was not done by human agency, it is an example of a biological method of 
controlling a species. Similar methods have been employedby man in the 
campaigns against anopheles, by distributing large numbers of a small fish 
of American origin ( Gambusia ), which is a voracious eater of mosquito 
larvae, to the breeding places of mosqxiitoes in Europe, Africa, Asia, and 
the Philippines. Although these fish multiply rapidly, the result hoped for 
was not achieved except in the Istrian peninsula where anopheles were able 
to breed only in a few ponds of a special kind (lokvas) where gambusiae could 



Medical News Letter, Vol. 27, No. 5 



19 



feed on them freely. Such favorable circumstances were not often foxind 
els ewher e. 

Larvicides and gambusiae were intended to destroy the vector in the 
larval stage in water. As early as 1927, however, the League of Nations 
Malaria Commission emphasized the importance of destroying adult mos- 
quitoes in houses, where they are directly responsible for spreading malaria, 
because man is usually bitten during the night by anopheles. 

The spraying of pyrethrum, or "flitting, " as it was sometimes called, 
then began and gave very good results in South Africa (1931), in India, and 
in the Netherlands. This spraying, however, needs to be repeated at least 
once a week and is, therefore, not practical as a large-scale public health 
measure. 

During the last war, the Swiss scientist and Nobel prize winner, 
Paul MuUer, discovered that dichloro -diphenyl -trichloroethane (DDT) was 
a very effective insecticide which killed insects by simple contact. More- 
over—and this is a great advantage — when it is sprayed on walls, it remains 
deadly for weeks and months to insects which come into contact with it for 
only a few moments. Therefore, by spraying the inside walls of houses with 
one of the residual insecticides (not only DDT, but benzene hexachloride (BHC), 
chlordane or dieldrin) a country can be protected at a uniform per capita cost, 
whether the inhabitants are many or few or whether they live in towns or in 
very small communities. This cost is rather low. In South East Asia, it 
is about 11 U.S. cents per person per year; in the Western Pacific, 17 cents; 
and in the Americas, about 45 cents. 

In this way, a method of preventing rural malaria was at last found. 
Since these insecticides were discovered, the governments of countries 
where malaria is rife, as well as interested international organizations, 
have devoted considerable effort to large-scale antimalaria campaigns 
designed to control the disease throughout the affected areas. In many coun- 
tries, where the disease had previously gone unchecked, it was found that 
malaria control was economically feasible and infinitely worthwhile; in others, 
such as Italy, where until recently methods like drainage, larval control, 
distribution of quinine, screening of houses and land reclamation were used, 
this one single method was substituted and found to be more economical and 
effective than all the others put together. 

However, a new problem has arisen involving a new threat: some of 
the malaria-carrying anopheles are developing resistance to the new insec- 
ticides. It would seem that such resistance takes some years to develop, 
but it also seems that, once it is established to any one of the four chemicals 
mentioned above, resistance to the others may develop within a few months. 
This has already happened in Greece. Fortunately, most people suffering 
from malaria get rid of their infection, even without treatment, in a period 
of one to three years unless the attack is fatal or they become reinfected. 
Therefore, as effective insecticide campaigns can prevent the occurrence 



4 

20 



Medical News Letter, Vol. 27, No. 5 



of new cases, and provided the treated zones are large enough to obviate 
the importation of infection from outside, a few years of spraying should 
be enough to secure the total eradication of malaria. This has already 
been achieved in several regions and the principal aim now is also to attain 
this goal elsewhere before resistance to insecticides can develop. When 
this objective is reached, insecticide campaigns can be discontinued and 
the cost of malaria control will cease to be a burden on national health 
budgets. This is the strategy recommended by the World Health Organ- 
ization, and it has already been adopted by many countries all over the 
world. (Dr. E. J. Pampana, World Health Organization) 

****** 
A Letter from CNQ 

The following paragraph is quoted from a letter written by the Chief of 
Naval Operations. 

"Thank you for your fine letter. The hospital overhaul does 
not seem to affect your high spirits, and your praise of the doctors 
and nurses is very much appreciated. The Navy has the finest 
Medical Corps in the world, and we may all be proud of the great 
work they are doing. " 

3^ J§I s{l Sj; sjc 3{! 

BuMed Circular Letters 



Requests are still being received for copies of individual BuMed 
circular letters and for the Bulletin of Bureau of Medicine and Surgery 
Circular Letters. This material is no longer current as all of the circular 
letters have been canceled by (1) superseding Instructions, (2) individual 
cancellation Notices, (3) SecNav Notice 5215 of 11 July 1955; Subj: Cancel- 
lation of certain directive -type SecNav letters, general messages, and 
Navy Department Bulletin items, or (4) the SecNav consolidated cancel - 
lation Notices. (AdmDiv, BuMed) 

3{c s{c ?jc *^ 

Postgraduate Short Courses for Medical Officers 

1. The following postgraduate short courses will be given as indicated. 
Eligible officers are those who meet the criteria prescribed by BuMed 
Instruction 1520.8 of 6 February 1956, 



Medical News Letter, Vol. 27, No. 5 



21 



2. Eligible and interested officers should forward requests via official 
channels, addressed to the Chief of the Bureau of Medicine and Surgery. 
Requests for attendance must be received in BuMed at least 30 days prior 
to commencement of the course requested. Travel and per diem orders 
chargeable against Bureau funds will be authorized those approved for atten- 
danc e . 



Course 



Surgery in Acute Trauma 



* Management of Mass 

Casualties 

* Medical Care of Atomic 

Casualties 

Application of Histochemistry 
to Pathology 

Obstetrics and Gynecology 
Seminar 



Radiobiology 



Location 



Dates 



Walter Reed Army Medical 2-6 April 1956 
Center 

Brooke Army Medical Center " " 
Fitzsimons Army Hospital " " 

Letter man Army Hospital " " 

William Beaumont Army 
Hospital 

Madigan Army Hospital " " 



Brooke Army Medical Center 16-20 Apr. 1956 

4-9 June 1956 



Walter Reed Army Medical 
Center 



Armed Forces Institute of 
Pathology 

Walter Reed Army Medical 
Center 

Walter Reed Army Medical 
Center 



Symposium on Cardiovascular Armed Forces Institute of 
Diseases Pathology 



7-9 May 1956 
9-13 April 1956 
9-iI April 1956 



14-17 May 1956 



* These two courses are identical in course content. (FrofDiv, BuMed) 

****** 



Correction 



Reference to footnote, page 3, Medical News Letter, Index, Volume 26: 
"Number 1" should read "Number 4. " 



22 



Medical News Letter, Vol. 27, No. 5 



Radiobiology Course 

Announcement has been made by the Armed Forces Special Weapons 
Project of a course for Medical and Medical Service Corps officers in 
Radiobiology to be given at Reed College, Portland, Ore. The course will 
convene m July 1956 and end about 3 May 1957. The tentative schedule for 
the class is as follows: 



Part I 



Part II 



Part m 



Academic Traini ng 
Industrial Health Physics 
Special Medical Orientation 



£Hliy Mass Casualty Course 



Reed College, Portland, Ore. 
9 July - 21 December 1956 

Hanford "Works, Hanford, Wash. 
7 January - 15 February 1957 

a. Nevada Test Site, Nev. 

25 February - 28 February '57 

b, Sandia Base, N. M. 

4 March - 15 March 1957 

Walter Reed Army Institute of 
Research, Washington, D. C. 
25 March - 3 May 1957 



The objectives of this training are to provide Medical and Medical 
Service Corps officers with sufficient technical background to serve as 
Staff Advisors in all phases of the medical aspects of atomic defense- as 
advisors m the medical problems associated with the use of atomic reactors 
for power purposes; and as instructors in the various Service training centers 
m this specialty. ^ 

Continuing progress in the field of nuclear energy and atomic research 
means an increasing need for Medical officers and Medical Service Corps 
officers trained in radiobiology. Nuclear powered submarines have been 
launched and more will be launched within the next few years Nuclear 
powered surface ships are planned. There are land based prototypes of the 
ship reacfors at several sites at present, and more of these may come into 
operation within the next few years. The Naval Reactor Program needs 
trained Medical and Medical Service Corps officers to fill new billets as 
they develop. 

The Navy Medical Department also has six clinical radioisotope labor- 
atories and is conducting studies in the field of radiobiology at several re- 
search laboratories. 

The course sponsored by the Armed Forces Special Weapons Project 
m Radiobiology will provide training needed for the types of billets described. 



Medical News Letter, Vol. 27, No. 5 



23 



Requests are desired immediately from Medical and Medical Service Corps 
officers of the regular Navy and the Naval Reserve in the ranks of Comman- 
der and below who are interested in this field of study. In accordance with 
BuMed Instruction 1520. 7 of 4 August 1954, each request for this course 
must contain the applicant's agreement to serve for a period of two (2) 
years after completion of the course, or for two (2) years following com- 
pletion of any obligated service whichever is longer. Requests must reach 
BuMed prior to 1 May 1956, and may be made by dispatch if the time element 
involved requires such action. Dispatch requests must be confirmed by a 
following letter. (Special Weapons Defense Division, BuMed) 

3^ 9{c ijc 3{C Sjc 3^ 

Symposium on Acute Trauma 



The Commanding General, Tripler Army Hospital, has named April 
2-6 inclusive as dates for the Hospital's symposium on acute trauma. The 
discussion will deal primarily with noncombat type trauma such as training 
injuries, traffic accidents, and household mishaps. 

An attendance of 200 Island doctors, civilian and military, is expected 
for the 5-day conference. 

Subject matter will emphasize case histories, supplemented by slides, 
graphs, and tabular data. The program schedule follows: 



April 2, a.m. The Body Reaction to Injury 

April 2, p.m. The Body Reaction to Injury (continued) 

April 3, a.m. Injuries of the Head - Central Nervous System 

April 3, p.m. Thoracic Injuries 

April 4, a.m. Abdominal Injuries 

April 4, p.m. Skeletal, Trunk, Urinary Tract Injuries 

April 5, a,m. Thermal, Traumatic Soft Tissue Injuries 

April 5, p.m. Soft Tissue Injuries (continued) 

April 6, a. m. Skeletal Injuries - Upper Extremity 

April, 6, p.m. Skeletal Injuries - Lower Extremity 

(TIO, Tripler Army Hospital) 

kjc 3^ jjc 9}g 9jc sjc 

From the Note Book 



1. The purpose of Navy Medical Department Training is: (1) to achieve 
and maintain professional standards of medical care comparable to that 
encountered in superior medical facilities in civilian life; (2) for the 



24 



Medical News Letter, Vol. 27, No. 5 



continuous advancement of naval medicine; (3) to attract and retain young 
physicians in naval medicine; and (4) to insure that the talents of able phys- 
icians have full opportunity for growth and utilization in their field of special 
interest and training. (Fiscal Program, BuMed) 

2. Captain D. W. Miller, MC USN, will represent the Bureau of Medicine 
and Surgery, and present a paper titled, "Treatment of Burns. " at the Sixth 
Middle East Medical Assembly, Beirut, Lebanon, April 6-8, 1 956. {TIO, BuMed) 

3. LTCDR P. D. Doolan, MC USN, has been commended by the Surgeon 
General for his work as Chief of the Research Division and Metabolic Research 
Facility, USNH, Oakland, where he has been on duty since February 1953 
Admiral Hogan's letter stated that the accomplishments of the Metabolic 
Research Facility under Dr. Doolan's direction have been a source of pride 

to the entire Navy Medical Department and that Dr. Doolan has established 
an outstanding reputation in the Service and among civilian members of the 
medical profession. (TIO, BuMed) 

4 The procurement program for the Supply and Administration Section of 
the Medical Service Corps, USNR, has been modified to include the commis- 
sioning of civilian hospital administrators. Applicants must hold a master's 
degree in hospital administration from one of the universities listed in Re 
cruiting Service Instruction 351. 4, and must be under 32 years of age at time 

J'/cKT^xf Tn^;^.^"*- ^PPO^^i^^^ts will be made in the grade of Ensign. MSG, 
UbJNK. (TIO, BuMed) 

5 An article entitled "Splenic -Gonadal Fusion. " by W. G. J. Putschar, and 
W. C. Manion. appeared in the Jan-Feb 1956 issue of the American Journal 

of Pathology. Twenty-six cases of gonadal-splenic fusion {fusion of the ovary 
or the testis with the spleen) collected from the literature have been studied 
m conjunction with four new cases from the Armed Forces Institute of Path- 
ology. (AFIP) 

6. Eighty-seven benign strictures of the bile ducts are considered Patients 
were subjected to 125 reconstructive procedures. A definite percentage of 
strictures after cholecystectomy or choledochostomy are due to the patient's 
primary disease and not to operative trauma. (New England J. Med. , 12 Jan 
1956; G. A. Donaldson, M. D. , A. W. Allen, M.D., M. K. Artlett, M. D. ) 

7. The direct instillation of nitrogen mustard into malignant effusions is 
as effective as radioactive colloidal gold in decreasing or eliminating fluid 
accumulation. Therapy with radioactive gold may be initiated later if nitro- 
gen mustard does not produce the desired result. (Geriatrics. January 1956; 
A.S. Weisberger, M.D. , F.J. Bonte, M.D., L. G. Suhrland. M. D ) 



Medical News Letter, Vol. 27, No. 5 



25 



BUMED INSTRUCTION 1920 • ' ^ 3 February 1956 

From; Chief, Bureau of Medicine and Surgery 

COMs all NavTraCens; COs all NavHosps, CLUSA: COs all 
NacRecStas, CLUSA; CGs and COs, all MarCorps Activities, 
CLUSA 

Certificates relative to a full and fair hearing in the case of 
officer personnel recommended for discharge by reason of physical 
disability 

(a) Section 0901 (1955) Naval Supplement Manual for Courts - 
Martial 

(b) BuMedlnst 1910. 2A, Subj: Disposition of enlisted and inducted 
members by reason of physical disability or military unfitness; 
standards and procedures for 

This instruction prescribes certain administrative procedures in connection 
with the discharge of officers by reason of physical disability. 

3fi ^ 3(£ 9{C sfc 3^ 

BUMED INSTRUCTION 6820. 4C 10 February 1956 

From: Chief, Bureau of Medicine and Surgery 

To: Ships and Stations Having Medical/Dental Personnel Regularly 
Assigned 

Medical and dental professional and technical books; procure- 
ment of 

(a) OpNavInst 7100.2 of 6 Jun 1951 (NOTAL), Subj: U.S. Naval 
Stations, financial responsibilities for 

(b) SecNavInst 7600. 3 of 3 May 1955 (NOTAL), Subj: Financial 
responsibility for maintenance and operation of medical and 
dental facilities at activities operating under the Navy Indus- 
trial Fund and certain other industrial type activities. 

This instruction informs addressess of the procedure to be followed in the 
procurement of professional and technical medical and dental books, 

BuMed Instruction 6820, 4B is canceled, , 

3}: 9}: si: 4: 



Subj : 



Ref: 



Subj: 
Ref: 



26 



Medical News Letter, Vol. 27, No. 5 




Correspondence Course Guide for Dental Officers 

This information is published in response to the many requests re- 
ceived from active and inactive dental officers for assistance in selecting 
naval correspondence courses which will help them prepare for the respon- 
sibility of higher grades. The courses listed in this article are designed 
to accomplish the following: 

1. Provide an understanding of the basic principles and policies in 
the organization of the Department of Defense and in the planning, control, 
and administration of the Naval Establishment. 

2. Provide a knowledge essential to the efficient operation and man- 
agement of dental activities in the Navy and Marine Corps. 

3. Provide promotion and/or retirement points for Reserve dental 
officers who are not on active duty. 

The exclusion of information on dental professional subjects from 
this article in no way detracts from the primary importance of dental pro- 
fessional training and duties. Information on this type of training for dental 
officers is contained in BuMed Instruction 1520. 2C of 19 December 1955. 

A complete list of naval officer correspondence courses maybe found 
in the Catalog of Officer Correspondence Courses - NavPers 10800A. The 
following courses are considered especially valuable in preparing dental 
officers to meet the naval responsibilities of their present and next higher 
grade. 

Recommended for Dental Officers in the Grade of Lieutenant. Junior Gfade : 



Assignments Reserve Points 

1. Naval Orientation NavPers 10900 H 

2. Naval Regulations NavPers 10740A 12 

3. Military Justice in the Navy - 12 

NavPers 10993 ' 

4. Dental Department Administration - 

BuMed (available about July 1956) 



24 
24 
24 



Medical News Letter, Vol. 27, No. 5 
Recommended for Dental Officers in the Grade of Lieutenant : 



27 



Course Assignments Reserve Points 

1. Navy Regulations - NavPers 10740A 12 24 

2. Leadership - NavPers 10903 5 . 10 

3. Military Justice in the Navy - 

NavPers 10993 12 24 

4. Dental Department Admini strati on - 

BuMed (available about July 1956) 

R ecommended for Dental Officers in the Grade of Lieutenant Commander : 

Course Assignments Reserve Points 

1. Security of Classified Matter - 3 6 

NavPers 10975A 

2. Education and Training Part I - 7 14 

' NavPers 10965 

3. Education and Training Part II - 5 10 

NavPel-s 10966 

4. Military Justice in the Navy - 12 24 

NavPers 10993 

5. Dental Department Administra- 

tion BuMed (available about 
July 1956) 

6. U.S. Naval Dental Clinic Adminis- 

tration BuMed (available about 
July 1958) 

Recommended for Dental Officers in the Grades of Command er and Captain: 

Course Assignments Reserve Points 

1 . Organization for National 

Security - NavPers 1.0721 5 iq 

2. Personnel Administration - Nav 

Pers 10968 6 12 

3. Public Information - NavPers 

10720 6 12 

4. Military Justice in the Navy - 

NavPers 10993 12 24 

5. Logistics - NavPers 10902 6 12 

6. U.S. Naval Dental Clinic Administra- 

tion - BuMed (available about July 

1958) - - 

7. Operational Planning and Staff 

Organization - Naval War College 4 24 



28 



Medical News Letter, Vol, 27, No. 5 



Requests for enrollment in correspondence courses with NavPers 
numbers should be on NavPers Form 992 to the U.S. Naval Correspond- 
ence Center, Building RF, U.S. Naval Base, Brooklyn, N. Y. Requests 
for enrollment in BuMed courses should be on NavPers Form 992 to the 
Commanding Officer, U.S. Naval Dental School, NNMC, Bethesda, Md. 
Requests for enrollment in a Naval "War College course should be by official 
letter to President, Naval War College, New port, R.I. All Naval officer 
correspondence courses are designed and intended for individual home study. 

****** 



Interesting Films Available at District 
and Fleet Film Libraries 



Dental Films: 

Equilibration of Occlusion 
Sound, color, I6mm 
Running time 20 minutes 
MN - 7340 

Aseptic Procedure in Oral Surgery 
Sound; color, i6mm 
Running time 18 minutes 
MN - 7830 

Partial Dentures, Biomechanics 
Sound, color, I6mm 
Running time 16 minutes 
MN - 6721 

Complete Dentures, Alginate Impres- 
sions 

Sound, color, I6mm 
Running time 18 minutes 
MN - 6720 

Complicated Exodontia, Introduction 
Sound, color, I6mm 
Running time 19 minutes 
MN - 6722 



Periodontia 

Color, sound, I6mm 
Running time 18 minutes 
MN - 5370 

Operative Dentistry - Preparation 

of Cavity 
Color, sound, l6mm 

Running time 10 minutes 

MN - 5369B 

Operative Dentistry Matrix 
Color, sound, I6mm 
Running time 6 minutes 
MN - 5369C 

Operative Dentistry - Amalgam 
Restoration 
Color, sound, l6mm 
Running time 12 minutes 
MN - 5369D 

Emergency Dental Treatment 
Color, sound, I6mm 
Running time 20 minutes 
MN - 6723 



Medical News Letter, Vol. 27, No. 5 



29 



Jacket Crown Construction 
Color, sound l6mm 
Running time 33 minutes 
MN - 5371 

First Aid Films 



Sucking Wounds of the Chest 
Color, sound, I6mm 
Running time 14 minutes 
MN - 7477 

Penetrating Wounds of the Abdomen 
Color, sound, I6mm 
Running time 14 minutes 
MN - 7470 

Use of Whole Blood, Plasma, and 
Serum Albumin 
Color, sound, l6mm 
Running time 15 minutes 
MN - 7335 



Cricothyroidotomy 

Blackand White, sound, I6mm 
Running time 11 minutes 
MN - 7469 

Taking Blood Pressure 

Black and White, sound, l6mm 
Running time 7 minutes 
MN - 1511g 

Artificial Respiration: The Back- 
pressure - Armlift Method 
Black and White, sound, l6mm 
Running time 19 minutes 
MN - 7484 



yji ik ^ A :llf: 



MEDICM RESERVE SECTIOf^ 



Available Appointments in Medical Service Corps, USNR 



The Recruiting Service has recently been authorized to recruit from 
civilian sources qualified applicants to fill vacancies in the Supply and 
Administration Sections, Medical Service Corps, U.S. Naval Reserve. 

The qualifications for appointment are: 

1. Must be a graduate of an accredited college or university with 

a baccalaureate degree and have completed an advanced course of instruc- 
tion at one of the approved schools listed below, earning a master's degree 
in Hospital Administration; or 

2. Members of the Hospital Corps of the Naval Reserve not on active 
duty, whose permanent status is chief warrant officer, warrant officer. 




30 



Medical News Letter, Vol. 27, No. 5 



, chief hospital corpsman, chief dental technician, hospital corpsman first 
class, or dental technician first class, are eligible to apply provided they 
meet the following requirements: 

a. Must have successfully completed four semesters {two years) 
toward a degree in an accredited college or university, or have satisfac- 
torily completed the USAFI Educational Qualification Test 2CX, prior to 

1 January 1954, or be a high school graduate, or have the service accepted 
equivalent as set forth in BuPers Instruction 1560. 1, and have a GCT or 
ARl score of at least 60. Results of tests given must be available in the 
applicant's record in the absence of the formal educational requirement. 

b. Must be a petty officer first class or higher in the Hospital 
Corps of the Naval Reserve and have held such status for at least one year 
prior to date of application. 

c. Must be attached to or associated with a pay or non -pay unit 
of the Naval Reserve, 



The schools approved under this plan from which 
accepted follow: 

University of California, School of Public Health 
University of Chicago, School of Business 
Columbia University, School of Public Health 
State University of Iowa, Graduate College 
John Hopkins University, School of Hygiene and 

Public Health 
University of Minnesota, School of Public Health 
Northwestern University, School of Commerce 
University of Pittsburgh, Graduate School of 

Public Health 
St. Louis University, Graduate School 
Washington University, School of Medicine, 

Lepartment of Hospital Administration 
Yale University, School of Medicine, Department 

of Public Health 
University of Toronto, School of Hygiene 



applicants may be 

Berkeley, Calif, 
Chicago, 111. 
New York, N. Y. 
Iowa City, Iowa 
Baltimore, Md. 

Minneapolis , Minn. 
Chicago, 111. 
Pittsburgh, Pa. 

St. Louis, Mo. 

St. Louis, Mo. 

New Haven, Conn. 
Toronto, Canada 



Medico -Dental Symposium for the Armed Forces 
First Naval District 



A three -day medical and dental symposium for members of the Armed 
Forces is scheduled to convene on 21 March 1956, at the U.S. Naval Hos- 
pital, Chelsea, Mass. The theme topic will be "Developments in Military 
Medicine and Dentistry, with Special Emphasis on Atomic Warfare, Special 
Weapons, and Isotopes. " 



Medical News Letter, Vol. 27, No. 5 



31 



The awarding of retirement point credits to Reserve officers in good 

standing who attend has been authorized. Registration at activities attended 

is required daily. 

The wearing of the uniform is optional, . - 

Programs and additional information concerning this symposium may 

be obtained by writing to: District Medical Officer, First Naval District 

Headquarters, 495 Summer St. , Boston 10, Mass. 

****** 

X-R ay Physics and Techniques - 
New Correspondence Course 

This new correspondence course {NavPers 10702) is now ready for 
distribution to eligible Regular and Reserve officer and enlisted Armed 
Forces Medical Department personnel. 

The development of x-ray machines in recent years has been character- 
ized by great improvement as to protection from electrical hazards, increased 
capacity and numerous automatic adjustments. The textbook, "Fundamentals 
of X-Ray Physics and Technique" provides general information on the theory 
of x-rays and electricity, specific information on the operation of many types 
of x-ray machines, and a description of the practical applications of radio- 
graphic technique to various medical problems. Completion of this course 
will provide physicians as well as x-ray technicians and watch standing 
personnel with well grounded information in the fundamental principles of 
x-ray physics and technique along with biological hazards involved. Medical 
Department officers should encourage interested Hospital Corps personnel, 
watch standing personnel, and particularly those personnel desirous of, and 
recommended for, a course of instruction in x-ray technique, to enroll in 
this correspondence course. 

Consisting of four objective question -type assignments, this course 
is evaluated at 12 promotion and nondisability retirement points. Applica- 
tions for this course should be submitted on Form NavPers 992 and forwarded 
via appropriate official channels to the Commanding Officer, U S Naval 
Medical School, National Naval Medical Center, Bethesda, Md. 

Naval Reserve officer and enlisted personnel who have completed the 
Special Clinical Services (general) correspondence course will not receive 
additional credit for completion of this course. (Naval Medical School, NNMC) 

****** 

Please forward requests for Change of Address for the News Letter to; 
Commanding Officer, U.S. Naval Medical School, National Naval Medical Center , 
Bethesda 14, Md. , giving full nam e, rank, corps, and old and new addresses. 



32 



Medical News Letter, Vol. 27, No. 5 




PREVENTIVE MEDICIIVE SECTIOIVI 



Poliomyelitis Vacc ine 

(This is the second in a series of articles designed to apprise Medical 
Department personnel of the current status of distribution of poliomyelitis 
vaccine to be used for dependents of Navy and Marine Corps personnel. ) 

The general plan for distribution of poliomyelitis vaccine to Navy 
and Marine Corps activities within the continental United States and the re- 
quiJ^ements which had been submitted from the Naval Districts and River 
Commands were outlined in the first article on this subject in the Preven-' 
tive Medicine Section of the February 3, 1956 issue of theNews Letter. The 
earlier article also reported details of the distribution of the 21, 780 cc. of 
vaccine available in the Navy supply system as of 10 January 1956. 

During the month of January, additional vaccine in the amount of 
30, 945 cc. was allocated to the Navy and was received in the supply depots. 
This was distributed to field activities during the week of January 30 to 
February 4. 1956. No further allocations have been made as of this writing. 
The quantities distributed to each Naval District are given in Table No. 1. 

Poliomyelitis vaccine shipped to date will cover about 29% of the' 
total requirements for the first dose, or 14. 5% of the requirements for a 
two-dose program, as submitted on 6 January 1956 by the Commandants. 
It has become evident, however, from the changes in requirements which 
have already reached the Bureau that the picture is somewhat more optimistic 
than these figures indicate. It is likely that, when new requirements are sub^ 
mitted on 30 March 1956, in accordance with BuMed Instruction 6230. 8, 
Sup I, the over all requirements will be considerably below those submitted 
on 6 January because of the inclusion of many dependent children in com- 
munity health department programs. Consequently, in the light of present 
production estimates, it seems quite probable that all Navy and Marine Corps 
dependent children between the ages of 6 months and 14 years, for whom 
vaccination is desired, will have received two doses of the vaccine before 
1 June 1956. It is still too early to estimate quantities of vaccine that may 
be available for older children or for third doses in those immunized prior 
to 1 January 1956. 



Medical News Letter, Vol. 27, No. 5 
Table No. I 



33 



District 


Two Dose 


Cubic Ceatimeters Shipped Prior Feb. 6, 1956 


Requirement 
in cc . 


First 


Second 


Total 


1 

s 
k 

SRNC 
PRNC 

5 
6 

8 

9 
11 
12 
13 


31,642 
12,400 
12,612 
2,072 
23,266 . 
103,300 
47,292 
15,684 
20,134 
64,342 
18,188 
11,336 


1,890 
.• 738 
765 
153 
1,404 

2,835 
936 
1,215 
3,852 
1,089 
702 


2,700 
1,080 

1,305 
2l6 
1,998 
, 0^0 
3,978 
918 
1,827 
5A99 
1,569 
999 


4,590 
1,818 
2,070 

369 
3,402 

6,813 
1,854 

3,o42 

9,351 
2,658 
1,701 


TOTAL 


362,268 


21,780 


30,9^*5 


52,725 



A total of 420, 000 cc. of vaccine had been received in the Depart- 
ment of Defense prior to 1 January 1956, including the gift of 72,900 cc. 
of vaccine from the National Foundation for Infantile Paralysis for immun- 
ization of children in the first and second grades of school overseas. The 
Navy received approximately one-third of this vaccine which was used to 
complete a two-dose program in children aged 6 months through 15 years 
and pregnant women overseas, because these dependents had no source 
of immunization other than that provided through the Armed Forces. 

Paragraph 3f of BuMed Instruction 6230. 8 of I6 September 1955, 
points out that an occasional case of poliomyelitis is to be expected follow- 
ing vaccination — particularly in periods of peak incidence. Should this occur 



34 



Medical News Letter, Vol. 27, No. 5 



the Bureau of Medicine and Surgery should be consulted by telephone or 
dispatch before administration of the vaccine is stopped on a wide scale. 
The Bureau can obtain information rapidly on any lot of vaccine that may 
come under suspicion relative to safety of administration. 

****** 
The 1956 Industrial Health Confe rence 

The 1956 Industrial Health Conference will be held at Convention 
Hall, Philadelphia, Pa. , from 21 April through 28 April 1956. This con- 
ference is jointly sponsored by the American Industrial Hygiene Association, 
American Governmental Industrial Hygienists, the American Association of' 
Industrial Nurses, the American Association of Industrial Dentists and the 
Industrial Medical Association. It is one of the most important educational 
meetings of the year for personnel employed in the industrial health program 
of the Navy. 

This conference affords unsurpassed opportunity for the presentation 
and discussion of new problems in the field of industrial health which have 
arisen incident to rapid technological progress. Recognized leaders in 
the field of industrial health will be present representing major private 
industries in the United States and Canada. There will be discussions of 
mechanisms believed to be most effective in lowering sick day absenteeism, 
in the prevention of lost time accidents, and in improving employee morale.' 
all of which are applicable in lowering the over all cost of industrial produc- 
tion and in maintaining a condition of readiness in the Navy. In order to 
have an adequate and progressive industrial health program in the Navy, 
it is considered highly desirable that naval and civilian personnel concerned 
with the industrial health program attend this conference. Such participa- 
tion is particularly pertinent at this time when an effort is still being made 
to integrate more civilian physicians into the Navy's industrial health pro- 
grams and to maintain and improve our present low rates of industrial 
sickness and accidents. 

It is highly recommended that industrial medical officers, industrial 
hygienists, and industrial nurses attend this important conference to the 
extent that their respective activities can spare them and that per diem funds 
can be made available. Since this conference is sponsored by non-federal 
organizations, orders for attendance must be processed in accordance with 
SecNav Instruction 4651. 8A. For this reason, applications for orders to 
attend should be processed at an early date. 



****** 



Medical News Letter, Vol. 27, No. 5 
Postgraduate Training in Preventive Medicine 



35 



There is a critical need for medical officers trained in the basic 
disciplines of public health: epidemiology, biostatistics , microbiology, 
sanitary engineering, and public health administration. 

Medical officers of the Regular Navy, lieutenant commander or below, 
who have had sea or foreign duty and who desire to specialize in preventive 
medicine, are invited to make immediate application for one academic year 
of postgraduate training beginning in August, September, or early October 
1956. The choice of school can be made for this training which may be 
taken at any one of the accredited schools of public health in the United States 
which offer a course leading to the degree of master of public health or an 
equivalent certificate. Applications should be forwarded as soon as possible 
to the Chief of the Bureau of Medicine and Surgery, via the commanding 
officer with a reference to this article, and should be accompanied by an 
appropriate obligated service agreement in accordance with BuMed Instruc- 
tion 1520. 7 of 4 August 1954. 

Several schools of public health also afford opportunity for specialized 
study in industrial health leading to the degree of master of industrial health. 

Among the interesting assignments available to young medical officers 
who successfully complete the course are; preventive medicine units ashore, 
both in the continental United States and in overseas areas, medical research 
units, preventive medicine duties at naval training stations, the Bureau of 
Medicine and Surgery, and various naval schools as instructors in such 
subjects as epidemiology, environmental health, preventive medicine, and 
related laboratory sciences. For those who major in industrial health, 
there are opportunities for assignment as industrial medical officers in the 
various naval industrial activities. The basic courses are also of value to 
any medical officer interested in clinical research, aviation medicine, sub- 
marine medicine, preventive psychiatry, and various other facets of Navy 
medicine. 

The broad knowledge and experience to be gained in a successful career 
in preventive medicine, whether it be in public health or occupational health 
in the Navy, provides outstanding preparation for the responsibilities to be 
assumed with advancement in rank through the senior grades. It also pro- 
vides the background necessary for appointment to many occupational health 
positions, public health positions, and teaching posts in civilian medicine 
when the Navy career is completed. Successful completion of this training 
meets part of the academic requirement for the American Board of Preventive 
Medicine and for certification by examination in public health, aviation med- 
icine, or occupational medicine. 

At least four or five more applicants are urgently needed this year to 
fill existing vacancies in the preventive medicine service of the Navy. Can- 
didates desiring more information on postgraduate training in preventive 



36 



Medical News Letter, Vol. 27, No. 5 



medicine are invited to direct their questions to the Bureau of Medicine 
and Surgery. 

ijc lie ij, « 

Postgraduate, Course in Venereal Disea se 

The 25th Venereal Disease Postgraduate Course, sponsored by the 
University of Washington School of Medicine and the Department of Health 
Education, and Welfare, Public Health Service, will be given at Seattle, Wash 
19 March through 23 March 1956. The course is designed to acquaint phys-' 
icians with the latest developments in the diagnosis, treatment, and manage- 
ment of venereal diseases. There will be no tuition charge for the course 
and physicians interested in attending the course should send applications 
to the University of Washington School of Medicine, Division of Postgraduate 
Medical Training, Harbor View Hospital Annex, 325 Ninth Avenue, Seattle 4 
Washington. ' 

Naval medical officers interested in attending should apply to the School 
as indicated above and should request TAD orders from their local comman- 
dants. Attendance at this course has the professional endorsement of the 
Biireau of Medicine and Surgery. 

ijc 4: ijc 4: :gc )lc 

Errata in Flip Charts for Food -Service Training 



Flip Charts for training food-service personnel (NavPers 230074) 
have been prepared for use in the Navy- food- service training program 
There are ninety, two 32" x 20" colored charts in the set. 

Instructions in sanitary precautions for food-service personnel has 
been republished as NavPers 91921A. The pass-out sheets-l6 tear sheets 
from NavMed P-1333— have also been republished as NavPers 91921A-1. 
Because the three publications were designed for joint use in the Food- 
Service Course, it was considered advisable to hold the Flip Charts for 
distribution with NavPers 91921A and 91921A^1 upon publication of the latter 
two. These publications are now in the process of being distributed. 

Before the Flip Charts are utilized for training, the following 'errata 
should be corrected: 



Series B 



B-2 Delete "L" in "BACTERIAL" by erasing or covering with heavy 
white paper or cardboard. 



Medical News Letter, Vol. 27, No. 5 37 

B-6 Insert a dash after "TISSUE ONLY" to clarify the meaning. 

B-8 Delete the letters "CLEANINESS" at the bottom of the chart by 
either erasing or covering them with white cardboard. 

Series C 

C-12 Correct spelling of "DYSENTERY" by erasing the letters "RY" and 
substituting "ERY" in black ink. 

Series E > 

E 2 Change "160° F. " to "161° F. " by covering the "0" with white 
cardboard on which "1" has been drawn with green crayon. 

E-II Delete "MAXIMUM" and shade with red pencil. 

Series F 

F-2 Correct spelling o£ "HARMFUL." by erasing the superfluous "L" 
and shading with red pencil. 

F-7 Change water temperatures from 120° and 140°F. to 140° and 

160°F respectively by covering "2" and "4" with white cardboard 
* squares and substituting "4" and "6" with green crayon. 

Series H 



H-15 Delete quotes in front of "EMIT" by erasing or covering with 

white cardboard. Insert quotes before "INKY" with red pencil. 

i^; ;^ gjc 

Immersion Foot 



(The clinical aspects and prevention of frostbite were discussed in the Pre- 
ventive Medicine Section of the Medical News Letter of December 9, 1955) 

Immersion foot and immersion hand designate a nonfreezing form of 
local cold injury resulting from intermittent or continuous exposure of the 
extremities to sea water at temperatures ranging from just above freezing 
in the high latitudes to relatively mild cold at lower latitudes. The severity 
of the injury is determined by the degree of cold and the duration of the 
exposure. 



38 



Medical News Letter, Vol. 27, No. 5 



The injury is characterized by temporary edema and hyperemia of 
the affected part accompanied by more lasting disturbances in function of 
autonomic, sensory, and motor nerve fibers with muscular weakness and 
atrophy in severe cases. Skin necrosis and vascular occlusion are less 
common than in frostbite. "Immersion foot" is a term coined by a surgeon 
of the British Navy in 1940. The condition is similar in its pathogenesis 
and clinical features to trench foot which took a large toll among ground 
troops in World War I. 

The essential condition for the development of immersion injury is 
prolonged exposure of poorly insulated extremities to cold. Wetness is 
important as a contributing factor because it destroys the insulating prop- 
erties of hand and foot gear and promotes loss of tissue heat by conduction. 
Other contributing factors of major importance are those which diminish 
blood flow to the extremities. These include the dependent position, im- 
mobility, direct and reflex vasoconstrictor effects of cold, increase in 
blood viscosity, and mechanical obstruction to arterial inflow and venous 
return by tight clothing and foot gear. Periodic vasodilatation in extrem- 
ities exposed to cold {the Lewis phenomenon) is a protective mechanism 
which is depressed or abolished with the advent of general body cooling. 
The limb is sacrificed, so to speak, when life is endangered by cold. 

One important effect of cold and the accompanying ischemia is a re- 
duced oxygen tension in the tissues of the extremity. Not only does less 
blood reach the tissue, but oxyhemoglobin dissociates less readily in the 
cold. The oxygen supply to peripheral tissues is reduced more by cold 
than are the metabolic needs, and a relative anoxia in the chilled tissue ^ 
is the result. Nerve and muscle which are susceptible to oxygen lack are 
the tissues which suffer most in immersion foot. Possible causal factors 
in addition to anoxia are the accumulation of normal metabolites and, 
perhaps, abnormal intermediate products as well as the direct effects of 
cold on cellular functions. 

Three stages are observed in the clinical course of immersion foot. 
In the prehyperemic stage, which is seen immediately after the victim is 
rescued, the extremity is cold; it is either blanched or mottled and cyan- 
otic in appearance with absent or sluggish flow in the skin vessels. The 
dorsalis pedis pulse is not palpable; mild to moderate edema is usually 
present. Superficial and deep sensation is absent, anesthesia being of the 
glove or stocking type. 

The second or hyperemic stage begins as body and tissue heat is 
restored. The affected part becomes red and hot with bounding arterial 
pulsations. Edema increases and may extend well beyond the original area 
of anesthesia. In severe cases, friability of the skin with blisters or patchy 
areas of necrosis is seen. Throbbing pain with burning and tingling sensa- 
tions are the predominant symptoms of this stage. Sweating is absent in 
the affected area. Critical modalities of sensation remain lost. Motor 



Medical News Letter, Vol. 27, No. 5 



39 



weakness or paralysis is common except in mild cases. The hyperemia 
stage reaches a peak in several hours, but the signs and symptoms of 
autonomic, sensory, and motor paralysis may persist for days or weeks. 

In the posthyperemic stage, hyperemia and edema subside. Resto- 
ration of autonomic activity is manifested by hyperhidrosis and vasomotor 
hyperactivity. Anesthesia gives way to hypesthesia, hyperalgesia, and 
hypersensitivity to cold. Stabbing pain maybe a distressing symptom. 
Muscular weakness with atrophy of the small muscles is frequent. This 
picture may gradually revert to normal in a period of months, but in severe 
cases these disabling symptoms, which resemble causalgia or Raynaud's 
syndrome, may last for years. 

Treatment of immersion foot in the prehyperemic stage consists of 
absolute bed rest, avoidance of trauma, and prevention of infection. The 
victim must not be allowed to walk. Unlike frostbite, rapid local rewarm- 
ing is to be avoided. The extremity lying horizontal beneath a cradle is 
allowed to warm gradually in air at room temperature (70 to 75° F. ). 
General hypothermia, however, must be promptly and vigorously correc- 
ted by external warmth applied to the body, but excluding the injured extre- 
mity. In later treatment, emphasis is on control of pain, correction of 
nutritional deficiencies, and continued avoidance of trauma and infection. 
Except for debriding blisters, surgery is indicated only when gangrene 
complicates the picture. In the posthyperemic stage, activity is gradually 
resumed. Exposure to cold and to excessive heat should be avoided. Auto- 
nomic blocking or sympathectomy may have a place in late treatment in 
order to control severe hyperhidrosis and vasomotor disturbances. 

Open rafts and life floats in use during World War II saved survivors 
of naval combat from drowning. Unfortunately, this type of survival equip- 
ment offered little protection against exposure to the cold sea and chilling 
winds. A tragically large number of survivors died from general hypo- 
thermia in the hours or days which elapsed before rescue arrived. Those 
who survived the rigors of cold and dehydration frequently sustained dis- 
abling immersion injuries of the feet and hands. A major step in the pre- 
vention of this serious loss of valuable lives and limbs has been the adoption 
of inflatable covered life boats as standard survival equipment by both the 
British and the United States Navy. Survivors can live for many days in 
relative comfort within such craft floating in cold areas of the sea. Never- 
theless, mild to moderate degrees of immersion foot can occur under these 
survival conditions as a result of prolonged contact of the feet with the cold 
damp deck of the life boat. Supporting the feet off the deck with life jackets, 
keeping the feet dry, and applying massage and body warmth are measures 
which will minimize this danger. Immersion hypothermia and its treatment 
will be discussed in a later issue. (David Minard, CDR MC USN, PrevMed 
Div, BuMed) 

****** 



40 



Medical News Letter, Vol. 27, No. 5 



Loaded Projectiles Used for Display and Ornamental 
Purposes at a Naval Hospital 

A request was received by a Naval District Explosives Ordnance 
Disposal Officer to inspect three 5-inch projectiles which were being used 
for display and decorative purposes at a naval hospital. Investigation re- 
vealed some startling facts. Although the projectiles were found to be 
unfuzed, they proved to be loaded and lethal. Subsequently, all similar 
displays on the grounds of this hospital were inspected, and twenty-three 
additional 8 -inch similarly loaded projectiles were found. All twenty- 
six projectiles were removed and disposed of in a safe location. 

In view of the startling revelations at this naval hospital, it is sug- 
gested that all naval activities undertake inspections to insure that every 
explosive projectile on display is inert and safe. 

The printing of this publication has been approved by the Director 
of the Bureau of the Budget, 16 May 1955. 



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